Question 1

Expert nurses learn to attend to a pattern of assessment data and act without consciously labeling it.These responses are referred to as:

Accepted Answer

Intuition is characterized by pattern recognition-expert nurses learn to attend to a pattern of assessment data and act without consciously labeling it.The other options are not correct.

Question 2

After completing an initial assessment of a patient,the nurse has charted that his respirations are eupneic and his pulse is 58 beats per minute.These types of data would be:

Accepted Answer

Objective data are what the health professional observes by inspecting,percussing,palpating,and auscultating during the physical examination.Subjective data is what the person says about him or herself during history taking.The terms reflective and introspective are not used to describe data.

Question 3

The nurse recognizes that the concept of prevention in describing health is essential because:

Accepted Answer

A natural progression to prevention rounds out the present concept of health.Guidelines to prevention place the emphasis on the link between health and personal behavior.

Question 4

The nurse knows that developing appropriate nursing interventions for a patient relies on the appropriateness of the __________ diagnosis.

Accepted Answer

An accurate nursing diagnosis provides the basis for the selection of nursing interventions to achieve outcomes for which the nurse is accountable.The other items do not contribute to the development of appropriate nursing interventions.

Question 5

The patient's record,laboratory studies,objective data,and subjective data combine to form the:

Accepted Answer

Together with the patient's record and laboratory studies,the objective and subjective data form the data base.The other items are not part of the patient's record,laboratory studies,or data.

Question 6

The nurse is conducting a class on priority setting for a group of new graduate nurses.Which is an example of a first-level priority problem?

Accepted Answer

First-level priority problems are those that are emergent,life threatening,and immediate (e.g.,establishing an airway,supporting breathing,maintaining circulation,monitoring abnormal vital signs)(see Table 1-1).

Question 7

When listening to a patient's breath sounds,the nurse is unsure of a sound that is heard.The nurse's next action should be to:

Accepted Answer

When unsure of a sound heard while listening to a patient's breath sounds,the nurse validates the data to ensure accuracy.If the nurse has less experience in an area,then he or she asks an expert to listen.

Question 8

During a staff meeting,nurses discuss the problems with accessing research studies to incorporate evidence-based clinical decision making into their practice.Which suggestion by the nurse manager would best help these problems?

Accepted Answer

Facilitating support for EBP would include teaching the nurses how to conduct electronic searches; time to visit the library may not be available for many nurses.Actually conducting research studies may be helpful in the long-run but not an immediate solution to reviewing existing research.

Question 9

A newly admitted patient is in acute pain,has not been sleeping well lately,and is having difficulty breathing.How should the nurse prioritize these problems?

Accepted Answer

First-level priority problems are immediate priorities,remembering the ABCs (airway,breathing,and circulation),followed by second-level problems,and then third-level problems.

Question 10

The nurse is performing a physical assessment on a newly admitted patient.An example of objective information obtained during the physical assessment includes the:

Accepted Answer

Objective data are the patient's record,laboratory studies,and condition that the health professional observes by inspecting,percussing,palpating,and auscultating during the physical examination.The other responses reflect subjective data.

Question 11

When considering priority setting of problems,the nurse keeps in mind that second-level priority problems include which of these aspects?

Accepted Answer

Second-level priority problems are those that require prompt intervention to forestall further deterioration (e.g.,mental status change,acute pain,abnormal laboratory values,risks to safety or security)(see Table 1-1).

Question 12

Which of these would be formulated by a nurse using diagnostic reasoning?

Accepted Answer

Diagnostic reasoning calls for the nurse to formulate a diagnostic hypothesis; the nursing process calls for a nursing diagnosis.

Question 13

A patient tells the nurse that he is very nervous,is nauseated,and "feels hot." These types of data would be:

Accepted Answer

Subjective data are what the person says about him or herself during history taking.Objective data are what the health professional observes by inspecting,percussing,palpating,and auscultating during the physical examination.The terms reflective and introspective are not used to describe data.

Question 14

What step of the nursing process includes data collection by health history,physical examination,and interview?

Accepted Answer

Data collection,including performing the health history,physical examination,and interview,is the assessment step of the nursing process (see Figure 1-2).

Question 15

When reviewing the concepts of health,the nurse recalls that the components of holistic health include which of these?

Accepted Answer

Consideration of the whole person is the essence of holistic health,which views the mind,body,and spirit as interdependent.The basis of disease originates from both the external environment and from within the person.Both the individual human and the external environment are open systems,continually changing and adapting,and each person is responsible for his or her own personal health state.

Question 16

The nurse is conducting a class for new graduate nurses.During the teaching session,the nurse should keep in mind that novice nurses,without a background of skills and experience from which to draw,are more likely to make their decisions using:

Accepted Answer

Novice nurses operate from a set of defined,structured rules.The expert practitioner uses intuitive links.

Question 17

Barriers to incorporating EBP include:

Accepted Answer

As individuals,nurses lack research skills in evaluating the quality of research studies,are isolated from other colleagues who are knowledgeable in research,and often lack the time to visit the library to read research.The other responses are not considered barriers.

Question 18

The nurse is reviewing information about evidence-based practice (EBP).Which statement best reflects EBP?

Accepted Answer

EBP is a systematic approach to practice that emphasizes the use of best evidence in combination with the clinician's experience,as well as patient preferences and values,when making decisions about care and treatment.EBP is more than simply using the best practice techniques to treat patients,and questioning tradition is important when no compelling and supportive research evidence exists.

Question 19

The nursing process is a sequential method of problem solving that nurses use and includes which steps?

Accepted Answer

The nursing process is a method of problem solving that includes assessment,diagnosis,outcome identification,planning,implementation,and evaluation.

Question 20

Which critical thinking skill helps the nurse see relationships among the data?

Accepted Answer

Clustering related cues helps the nurse see relationships among the data.

Quiz 1: Evidence-Based Assessment